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Irwin v. Mutual of Omaha Insurance Co.

United States District Court, W.D. Michigan, Southern Division

August 22, 2017

ANDREA IRWIN, Plaintiff,
v.
MUTUAL OF OMAHA INSURANCE COMPANY, Defendant.

          OPINION

          PAUL L. MALONEY UNITED STATES DISTRICT JUDGE.

         This action arises under the Employees Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1132(a)(1)(B). Before the Court is Plaintiff Andrea Irwin's motion to reverse Defendant's long-term disability benefits denial and motion for summary judgment. (ECF No. 11.) Upon careful review of the record, the Court has decided that the motion can be resolved without oral argument. See W.D. Mich. LCivR 7.3(d). For the reasons that follow, Plaintiff's motion is denied.

         I.

         Plaintiff worked as a production team member for Gentex Corporation (“Gentex”), and sought short-term and long-term disability benefits under a policy issued by United of Omaha Life Insurance Company (“United”) to Gentex. Plaintiff was an insured employee covered by this policy. Under the policy, United would pay insured persons short-term and long-term disability benefits to which they are entitled, subject to the terms, conditions, and limitations of the policy. (Policy, ECF No. 7-2, PageID.212.) It provides:

Disability and disabled mean that because of an Injury or Sickness, a significant change in Your mental or physical functional capacity has occurred, as a result of which:
a) during the Elimination Period, You are prevented from performing at least one of the Material Duties of Your Regular Job (on a part-time or full-time basis); and
b) after the Elimination Period, You are:
1. prevented from performing at least one of the Material Duties of Your Regular Job (on a part-time or full-time basis); and
2. unable to generate Current Earnings which exceed 99% of Your Basic Weekly Earnings due to that same Injury or Sickness.
Disability is determined relative to Your ability or inability to work. It is not determined by the availability of a suitable position with the Policyholder. [ ]
Elimination Period means the number of days of continuous Disability which must be satisfied before You are eligible to receive benefits. The elimination period is shown in the Schedule. [ ]
Material Duties means the essential tasks, functions, and operations relating to Your Regular Job that cannot be reasonably omitted or modified. [ ]
Regular Job means the occupation You are routinely performing when Your Disability begins.

(Id. at PageID.55-58; PageID.240-42.) Under the long-term policy, “[a]fter a Monthly Benefit has been paid for 3 years, Disability and Disabled mean You are unable to perform all of the Material Duties of any Gainful Occupation.” (Id. at PageID.55.) Also, instead of regular job, the long-term policy refers to regular occupation, which is defined as:

the occupation You are routinely performing when Your Disability begins. Your regular occupation is not limited to Your specific position held with the Policyholder, but will instead be considered to be a similar position or activity based on job descriptions included in the most current edition of the U.S. Department of Labor Direction of Occupational Titles. We will have the right to substitute or replace the DOT with another service or other information that We determine to be of comparable purpose, with or without notice. To determine Your regular occupation, We will look at Your occupation as it is normally performed in the national economy, instead of how work tasks are performed for a specific employer, at a specific location, or in a specific area or region.

(ECF No. 7-1, PageID.58.)

         On September 5, 2014, Plaintiff presented to David J. Barney, a certified physician's assistant, for a follow-up visit for depression and complaints of depressed mood and fatigue, which began approximately 10 years prior and had gradually improved since then. (Id. at PageID.107.) On February 13, 2015, Plaintiff presented to Barney with insomnia that had worsened since her last visit. (Id. at PageID.141.) Approximately two months later, Plaintiff saw Barney and complained of headaches for 3 days. (Id. at PageID.151.) On June 5, 2015, Plaintiff presented to Barney with fatigue, described as true arthritis and true exercise intolerance; her symptoms included insomnia, depression, and lack of interest in normal activities. (Id. at PageID.156.) Three weeks later, Plaintiff saw Barney for a follow-up appointment; she complained of anhedonia, depressed mood, insomnia, and loss of energy. (Id. at PageID.163.) On July 22, 2015, Plaintiff presented to Barney with pain in arms, knees, hips, bilateral elbows and wrists, described as aching and dull. Her symptoms included morning stiffness and weakness of hands ...


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